AZCEP

Two distinctly different situations there. Torsade is difficult to synchronize due to the changing deflections of the R wave. The monitor has a difficult time deciding what is an R and what isn't, so it won't sync with every one. With AF, even at fast rates, the R wave tends to be of the same deflection. Even the irregularity that occurs doesn't usually hinder the sync mode from flagging the R. Also as AF speeds up it tends to become more regular, due to the rate of repolarization being sped up as well.

Not enough. That is what we are trying to discuss here. If you don't have anything constructive to add, don't bother posting. It's not a matter of being impressed with ourselves so much as being ashamed of some of the posers that want to be considered a paramedic without the first clue of what that really means. Again, you aren't adding anything of value to the course of this discussion. Maybe you can remember a time when the requirements to become a paramedic were a bit more strenuous. Maybe you've decided the best use of the urban medic is BLS and fly. Your narrow view of what works is handicapping the progression of the rest of the industry. Unlike Ruff, I'm willing to bet that you've settled into your current position quite well. I'd even wager that the experience you've had has never been outside of a major receiving facility's catchment area. Knowing that you've got all the back up you will need within a moments reach makes everyone a better provider. Your argument about not needing more education is pathetic. It is the same argument that fire chiefs and ambulance system administrators use to prevent our advancement. You've yet to show any semblance of professionalism or education at your current level. I suppose we should not expect someone in your situation to recognize the need for more education.

I will agree that an experienced and educated provider is the ultimate goal. Unfortunately, the current system has left many with only a classroom education that is lacking in the ability to apply it in the street. There was a time that a new EMT could not attend a paramedic program without some street experience. Then it became acceptable to allow EMT's that spent their time on interfacility transports to attend ALS level classes. Currently in many places EMT's can leave their BLS classes, walk into an ALS program while the ink is still wet and be admitted. This is a dismal system failure, not the fault of the individuals. If we concede that an educated, and experienced provider is what we want, how would we go about creating them? My suggestion is to build it into the degree program itself. If the candidate has an associates level degree prior to entering the ALS program, we would be able to use more of the time to provide more field/clinical experience. A four year degreed paramedic with more than a two full years of clinical, vehicular, advanced level didactic exposure would be an asset in a rural or urban environment.

I think you may have missed something Dust. This particular fire department does not provide ambulance transport. They are primarily ALS first response, with an ALS ambulance sent from another provider. They may have a secondary transport role, but I'd have to check on that. This idea is to eliminate the utilization of a full engine company for calls that a two man crew, that won't transport anyway, can manage until the ALS ambulance arrives.

The best treatment for a sympathomimetic overdose is still long acting benzodiazepines, and altering absorption. The calcium channel blocker would control cardiac output, but do nothing for the CNS effects.

With a rate of 150, the lack of P-waves should indicate several different rhythms that would not respond adequately to Adenosine. The CAUSE of the tachycardia needs to be considered, not the treatment that will not have a favorable outcome to your patient.

Just a guess based on what little I know about the situation. Mesa FD has more stations and has shorter response times than the ambulance provider they work with, Southwest Ambulance. They are able to respond a QRV with full ALS quicker than they can send a fully staffed engine company cheaper than buying out the contract and certificate of necessity that Southwest currently holds. This way, they are still serving their tax base with ALS providers, and are not placed in a greater position of liability that would come from providing ambulance transport.

I'm not going to try to answer for Ruff, since I don't know him. This heart is working as hard as it possibly can. a dose of a beta-2 agonist will not change that. If you are using something like Isuprel, you might get a bad effect, but very few carry it. You might want to recheck your ACLS book also. If you are presented with a reversible cause, you treat it first. Fix the oxygen problem, the rate will be easier to manage.

http://www.nhtsa.dot.gov/people/injury/ems/EMT-P/ There's the links for the base requirements for all American paramedics. Some areas will add to this, but this is the minimum. The EMT curriculum is also available from the same site. Now to the question at hand. No, I would not work in Ontario. The competition for a job that I'm already doing with a comfortable salary without the level of taxation enjoyed in the province says "Nay". I'm all for more educated providers, but the comparison is a fairly weak one in this case. Taking a provider with an educational background out of a system that supports them, and placing them in one where they will not be able to perform what they have been educated to do just is not a good idea. I've tried this several times in different areas in the states, and the culture shock was impressive, at best. Oppressive at worst. As ncmedic alluded, the difference in scopes wouldn't be worth the increased pay. The change in scope would be backwards for most. Now, if you can offer up this educational program to some EMT candidates, there might be a calling.

Amiodarone is recommended to be administered over ten minutes, but it has been shown to not have any significant problems when administered more quickly. http://www.springerlink.com/content/p1726h29835772nv/ The article relates to a study done on dogs, but it shows that an aqueous solution of amiodarone can be pushed faster. The preservative/solvent issues are more of the problem. zzyxx is partly correct on Lidocaine working faster, though. The body will metabolize it quicker, as long as the liver is functioning. Downside, shorter half-life, so you end up redosing, or hanging a drip. Lidocaine will also cause more allergic reactions, hypotension, and vomiting due to the speed of administration.

The idea behind using RSI in the first place is to optimize the first view of the vocal cords. By using PAI, you may not get that optimal view that we are all striving for. Versed and Etomidate can be used this way, but if you are already knocking a patient down that far, adding a paralytic isn't too far of a leap. It will also make life much easier for everyone, particularly the patient. On the subject of alpha blockade, little to no discussion currently. Anesthesia occasionally considers it, but sticks with the old standbys.

Absolutely not. We have all worked with providers that had the bare minimum, and proved themselves extremely capable. I'd wager the flip side has also been true. If we are to gather the support of established medical professionals, this is but the launching point. Proving that we are willing to expand our own education helps to show a dedication to the craft that has been sorely lacking to this point. Using the Associates, or two-year degree as the prerequisites is an answer to this problem. Those that complete their degree in order to enter the EMS program, show that they are willing to dedicate themselves to the educational process. While this may not eliminate the bonification you describe, it would at least show that some of the baseline information has been achieved. Then we can build a system that is dedicated to the medicine portion, and ideally turn out better providers.

And there again, reduced supply with increased or similar demand results in greater wages. This is not going to change overnight, and the IAFC/IAFF/Any number of EMS administrators will fight it to the bitter end. An educated workforce would create bigger issues that those in charge would have to reconcile. The cries of the smaller agencies that bemoan the lack of qualified personnel would have to be dealt with. Much like the current system, shortages would happen for a period. The resulting providers would be more dedicated to the profession, and would be better suited to be independent practitioners at some point.

By increasing the educational requirements, you are in effect, causing a greater demand for those providers that are in the field. More demand, less supply eventually leads to greater salaries being made possible. This would take a significant time to happen. Attrition alone might reduce numbers and increase the workload for a while. Increasing the entry level education also would push EMS from a "technical" job to a profession. This is a status that Nursing finally achieved through a similar route. The entry level degree would also force those that choose to try EMS to put a bit more forthought into the choice. The mantra of "I'm going to try this for a while" has been outmoded, and should not be allowed to continue. From your post Ruffems, it seems that your view has over complicated matters. Continuing education is pursued more vigorously by those that spend more time in achieving their initial license. Knowing how much work it would be to restore it if it is lost self-limits the outcry of increasing requirements. This is not an easy subject to breach without many becoming threatened by the suggestion. It will be a cornerstone of the advancement of the craft.

Two year degree prior to being allowed to enter a paramedicine program. Get your EMT certification, obtain your Associate's degree, decide if EMS is really the profession you want to be in. Resulting in higher educated, more dedicated providers that better understand how EMS works. Perhaps it would eliminate the "passerby" attitude that some new providers bring with them. EMS is not a stepping stone. It is it's own specialized field of medicine. It does not reliably relate to any other medical endeavor. We need to create providers that can recognize this.

With the direction the current ECC guidelines are taking, if you can't learn from the ACLS provider manual what needs done and when, you really need to reconsider why you are an EMS provider. It is too simple for anyone to get lost by reading.

It's actually 26.67. This is the constant for Dopamine with a 1600 mcg/mL concentration. If your mix is different you will have a different number. If you lop off the 2/3rds of a drip, your drip rate will be off. The best way, by far, is to use an infusion pump when available.

Location, location, location Any structure burned to 2-3rd degree in areas of vital function can be fatal, as chbare described. Older patients don't do as well as younger ones, but this is not directly related to location of burn so much as it is the degree and percent.

Based on familiarity and cost, Morphine is my vote. The hypotension and nausea are easily controlled with reducing the rate of administration. The blood pressure reduction is also quite useful for some patients. I also appreciate a bit longer duration of action than Fentanyl can provide with single dosing. The fact that if we eliminate morphine, we would not have anything to replace it currently, leaves me with voting for morphine. Now, if we had enough Fentanyl to mix the infusion we would need, then maybe...

You've come to the right place, but be careful what you wish for. Take the drip rating and divide the number of drops by it to get mL delivered. Divide again by 60 for mL/hour. With 10gtt tubing, your 20gtt would equal 2 mL. With 60gtt, it would equal roughly 1/3rd of an mL. Relax a bit there. The drip factor is listed somewhere on the packaging. You just have to find it. Chances are it is 60 gtt/mL. A pediatric set and an adult set of the same drip factor are the same. Some will have buretrols, some won't. Just little things that make life easier when dealing with a kid. You're welcome.

The plaintiff's attorney will LOVE the fact that you are documenting inconsistently with the results received from your equipment.

Document the numbers as the equipment presents them.

The reason the B/P's are reported as even numbers stems from there not being odd numbers on a sphygmanometer's face. If you report an odd numbered B/P, and you've used an instrument with no odd numbers, how did you come to this information? One blood pressure, or pulse rate, or respiratory rate doesn't do anything for you anyway. Vital signs change on a moment to moment basis. Even in a cardiac arrest, the lack of a pulse initially may well be temporary. Ever have someone wake up while doing compressions with an indignant look? NIBP's use a more accurate digital sending unit for the pressures they report, so they are able to deliver odd numbered B/P's.

Was it on both sides, or just the one? It's not really a matter of what you name it, if you see bruising behind the ears, Battle's sign it is. If you see it behind only one, you might call it something else. ( :wink: chbare) Following a traumatic event with the energy transmission strong enough to cause the bruising, call it a "boo-boo", or an "OWIE", we should all have a pretty good idea of what you are trying to describe.

Here's a thought, if a bit off topic. How about putting a triage provider/PA/NP in a kiosk in the parking lot? Patient drives up, the "doc in a box" does an assessment and tells them what the best way for them to proceed would be. Part parking attendant/part triage desk/part referral service. Oh, and put a big bottle of Tylenol in the box with them. For all of the untreated fevers you know.